Francisci S., Gigli A., Guzzinati S. 

Conferenza iHEA

Milano, 12-15 luglio 2015



In most developed countries, cancer accounts for a major and increasing proportion of national health care expenditures. Measuring the burden of disease is of great interest to public health researchers and policy makers.

The objective of this study is to reconstruct the cancer pathway and the corresponding cost-related dynamic, according to a three-phase of care framework: initial (one year after diagnosis), continuing (all time occurring between initial and final) and final (one year before death).

The profiles of cancer related costs are reconstructed using administrative data, in particular hospital discharge cards, outpatients records and pharmaceutical data, linked at individual level with cancer registry data on all patients alive at a certain date (prevalence cohort) regardless of how long before they were diagnosed. Cancer prevalent cases are decomposed into three phases of care and corresponding costs are calculated using administrative data, in order to obtain an estimate of cancer-related costs of cancer by phase of care. Colon, rectum and breast are the cancer sites considered in the analysis; the Italian registries participating in the study are located in seven different regions, spanning from North to South: Friuli Venezia Giulia, Veneto, Tuscany, Umbria, Lazio, Campania, and Sicily.

Preliminary results for colorectal cancer applied to a cohort of patients registered in two cancer registries located in Veneto and Tuscany show cost profiles with very high costs during the first months of the initial phase, then declining until reaching a plateau during the continuing phase and then increasing again during the final phase of life.
A total expenditure of 44.5 million euros for 9 640 patients is estimated for Veneto CR, while 33.8 million Euros for 8 357 patients is for Tuscany CR. These figures correspond to about 4 300 euros per capita in 2006.
There is a trend in costs by stage at diagnosis in the initial phase: more advanced stages correspond to higher average costs, in all age classes, and particularly among the youngest. This result is consistent with the clinical guidelines, which suggest different treatment strategies according to the tumor stage. Age is also related to costs: younger patients have higher costs in all phases of the disease.

The main advantage of the phase of care approach is the estimation of patterns of care and costs at a given date that takes into account the cancer survivors' distribution and the corresponding care needs during their entire lifespan. The study confirms that stage at diagnosis has an influence on the therapeutic strategy and related costs. The results confirm the importance of primary prevention and early detection of cancer in a public health perspective, not only in the improvement of patients survival and but also in the economic sustainability of health care.